Pharmaceutical care needs of diabetic patients attending a pharmacist-run cardiovascular risk clinic

Cockburn, A. and Kinnear, M. and Warnock, C. (2009) Pharmaceutical care needs of diabetic patients attending a pharmacist-run cardiovascular risk clinic. Pharmacy World and Science, 31 (1). pp. 43-44. ISSN 0928-1231 (http://dx.doi.org/10.1007/s11096-008-9262-z)

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Abstract

Background and objective A Pharmacist-led Diabetes Cardiovascular Risk (DCVR) reduction clinic is established in a hospital out-patient setting to optimize treatment of hypertension and hyperlipidaemia in high-risk diabetic patients. The pharmaceutical care issues identified by the pharmacist have been categorized and the contributions made to improve adherence to national prescribing guidelines are described. Clinical outcomes associated with the clinic are reported elsewhere [1]. Design Retrospective review and categorization of pharmacist care plan documentation related to 134 patients who attended the clinic between 2003 and 2006. Setting Pharmacist-led cardiovascular risk clinic within the metabolic unit of a large teaching hospital. Main outcome measures Number and type of pharmaceutical care issues. Results The mean (SD) age was 63.7 (11.6) years, 51.5% were male and 91.8% had Type 2 Diabetes. Prior to establishing the pharmacistled cardiovascular clinic, a local audit of prescribing found three areas of low adherence to national prescribing guidelines [2]. The clinic pharmacist has addressed these, leading to 14 (10.4%) patients being started on an ACE inhibitor as well as 15 (12.4%) and 16 (13.2%)primary prevention patients (n = 121) being newly started on aspirin and statin therapy (respectively). Of 490 documented pharmaceutical care issues, 153 (31%) were lowering blood pressures to target by increasing doses of antihypertensives, 149 (30%) were adding new drugs and 59 (12%) were adverse drug reactions. The pharmacist undertook 1034 monitoring Pharm World Sci (2009) 31:40-141 43 123 checks and 941 recommended changes to patients medication. Most patient monitoring checks were effectiveness enquiries (731, 70.7%) and most drug therapy changes were drug selection issues (198, 21%). Conclusions The pharmacist addresses areas that a previous audit identified as having low adherence to national prescribing guidelines. Other pharmaceutical care issues addressed by the pharmacist were optimization of antihypertensive dosage, prescription of additional therapy and avoidance of adverse drug reactions. The prescribing criteria most frequently addressed by the pharmacist will be incorporated into a pharmaceutical care plan to ensure consistent delivery of care among clinic pharmacists and other members of the health care team.

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